Fibromyalgia

Question 1

What is fibromyalgia?

Answer 1

Chronic, widespread body pain characterised by widespread pain for at least 3 months in addition to fatigue, memory and sleep difficulties.

Question 2

What is the aetiology of fibromyalgia? (x3)

Answer 2

• Strong association in individuals and FAMILIES with IBS, temporomandibular joint disorder, cystitis and tension headaches.
• Association with psychiatric conditions such as depression and anxiety.
• STRESSORS: infection, injury, emotional trauma, peripheral pain syndrome such as RA or osteoarthritis.

Question 3

What is the pathophysiology of fibromyalgia?

Answer 3

CNS-driven pain amplification syndrome resulting in diffuse hyperalgesia (increased pain in response to normally painful stimuli) and allodynia (pain in response to normally non-painful stimuli). Since the pathology is CNS, other CNS-mediated symptoms are also seen.

Question 4

What is the epidemiology of fibromyalgia: Gender? Age?

Answer 4

Prevalence higher in women (perhaps because the (now old) 1990 criteria, requiring a certain number of tender points for diagnosis, was biased towards women who are inherently more tender than men). Age of onset peaks at 35 years.

Question 5

What are the signs and symptoms of fibromyalgia? (x6)

Answer 5

• Widespread, chronic pain with diffuse tenderness on examination. Tends to be more axial
• Fatigue unrelieved by rest
• Sleep disturbance
• Cognitive dysfunction (unknown whether primary or due to fatigue)
• Numbness/tingling/stiffness concomitant with pain
• Sensitivity to sensory stimuli such as bright lights, odours, noises

Question 6

What are the investigations for fibromyalgia? ((x4))

Answer 6

• Clinical diagnosis: over three months with associated fatigue, memory and sleep difficulties
• ESR/CRP normal, excludes inflammatory aetiology, TFTs exclude hypothyroidism, anti-CCP/RF/ANA to rule out autoimmune rheumatological pathologies, Vitamin D to rule out muscular pain from deficiency